ABSTRACT One in three adults over 65 fall each year. Medical alert devices, commonly worn as a pendant, can be used to signal for help in the event of a fall. Unfortunately, uptake and adherence of these devices has been limited. BioSensics has recently developed a novel medical alert solution called ActivePERS that is based on a wearable sensor and companion smartphone app. ActivePERS uses the customer's smartphone to make emergency calls; distinguishing it from other products that are tethered to a land-line or require a dedicated cellular connection with associated fees. In addition, with ActivePERS the consumer can decide if they want to pay for a professional monitoring service to respond to emergencies or save money by routing emergency calls to an assigned set of caregivers who could then contact emergency services as needed. There are four additional features of ActivePERS that address the limitations and common barriers to usage of traditional medical alert devices. Fall detection algorithms enable the device to signal for help if the wearer forgets to, or is incapable of, pressing the alert button. Fall risk assessment can help older adults and their caregivers decide when to initiate a conversation with a physician about fall prevention strategies and/or changes in level of care. Non-usage alerts help establish a habit of wearing the pendant. Activity tracking motivates users to stay active and makes the device more engaging, which further increases compliance. The objective of this Commercialization Readiness Proposal is to address several critical factors that are limiting the widespread adoption of ActivePERS. First, we will shrink the overall size of the wearable device, modify the industrial design so that it can be worn on the wrist or as a pendant, and improve manufacturing processes to support scale-up. The current ActivePERS solution must be worn as a pendant; however, with the advent of smartwatches older adults are increasingly opting for medical alert devices with a wrist-worn form factor. Second, we will replicate key clinical trials to test and validate fall detection and fall risk assessment algorithms for the wrist-worn form factor. Third, we will develop a novel hybrid medical alert solution by modifying ActivePERS hardware to support Bluetooth and sub-GHz radio protocols, and developing a compatible in-home base station to receive sub-GHz fall alerts and place outgoing emergency calls via landline or voice over IP (VoIP). Sub-GHz radio has much greater range than Bluetooth. With this base station, users will be able to move around their homes without worrying about being in range of their smartphone, or even whether their smartphone is turned on. This will give our customers the best of both worlds; a long-range in- home solution and a portable app-based solution. This will be the only medical alert device on the market that gives customers the option to avoid monthly fees or to add very cost-efficient professional monitoring to their service, which could have a significant impact on public health because in the US older adults typically do not have medical insurance coverage for a medical alert device and have to pay out of pocket.